Knowledge, attitude, and practice of healthcare professionals toward cognitive dysfunction in Parkinson's disease and cognitive rehabilitation.

BACKGROUND: To investigate the knowledge, attitude, and practice (KAP) of healthcare professionals regarding cognitive dysfunction and cognitive rehabilitation in Parkinson's disease (PD). METHODS: This multicenter, cross-sectional survey enrolled physicians and nurses in 10 hospitals between October 2022 and November 2022. A self-administered questionnaire was developed to collect the demographic information of the participants and their knowledge, attitude, and practice toward cognitive dysfunction in PD and cognitive rehabilitation. RESULTS: This study enrolled 224 physicians and 229 nurses. The knowledge, attitude, and practice scores were 12.57 ± 3.76 (total score: 22), 29.10 ± 3.71 (total score: 32), and 21.07 ± 8.03 (total score: 28) among physicians, and 9.97 ± 4.70 (total score: 22), 25.27 ± 8.96 (total score: 32), and 25.27 ± 8.96 (total score: 28) among nurses. Among physicians, the knowledge scores (OR = 4.23, 95%CI: 2.36-7.58, P < 0.001) and attitude scores (OR = 3.00, 95%CI: 1.67-5.37, P < 0.001) were independently associated with good practice. Among nurses, the knowledge scores (OR = 4.31, 95%CI: 2.31-8.05, P < 0.001), attitude scores (OR = 5.18, 95%CI: 2.82-9.53, P < 0.001), working department (Ref: rehabilitation; neurology: OR = 2.26, 95%CI: 1.01-5.08, P = 0.048; public health service/chronic disease follow-up center: OR = 2.98, 95%CI: 1.12-7.92, P = 0.028) were independently associated with good practice. CONCLUSIONS: Physicians and nurses have insufficient knowledge, favorable attitudes, and active practice regarding cognitive dysfunction and cognitive rehabilitation in PD. This study identified gaps in KAP and suggested education activities to improve the KAP toward cognitive dysfunction in PD.

Using Ultrahigh b -Value Diffusion-Weighted Imaging to Noninvasively Assess Renal Fibrosis in a Rabbit Model of Renal Artery Stenosis.

OBJECTIVE: This study aimed to investigate the feasibility of diffusion-weighted imaging with ultrahigh b values ( ub DWI) for the evaluation of renal fibrosis (RF) induced by renal artery stenosis (RAS) in a rabbit model. METHODS: Thirty-two rabbits underwent left RAS operation, whereas 8 rabbits received sham surgery. All rabbits underwent ub DWI ( b = 0-4500 s/mm 2 ). The standard apparent diffusion coefficient (ADC st ), molecular diffusion coefficient ( D ), perfusion fraction ( f ), perfusion-related diffusion coefficient ( D *) and ultrahigh apparent diffusion coefficient (ADC uh ) were longitudinally assessed before operation and at weeks 2, 4, and 6 after operation. The degree of interstitial fibrosis and the expression of aquaporin (AQP) 1 and AQP2 were determined through pathological examination. RESULTS: In the stenotic kidney, the ADC st , D , f , and ADC uh values of the renal parenchyma significantly decreased compared with those at baseline (all P < 0.05), whereas the D * values significantly increased after RAS induction ( P < 0.05). The ADC st , D , D *, and f were weakly to moderately correlated with interstitial fibrosis as well as with the expression of AQP1 and AQP2. Furthermore, the ADC uh negatively correlated with interstitial fibrosis ( ρ = -0.782, P < 0.001) and positively correlated with AQP1 and AQP2 expression ( ρ = 0.794, P < 0.001, and ρ = 0.789, P < 0.001, respectively). CONCLUSIONS: Diffusion-weighted imaging with ultrahigh b values shows the potential for noninvasive assessment of the progression of RF in rabbits with unilateral RAS. The ADC uh derived from ub DWI could reflect the expression of AQPs in RF.

Eating behavior associated with gray matter volume alternations: A voxel based morphometry study.

UNLABELLED: Little is known about whether eating behavior is associated with alterations of brain structure or whether the possible alterations are related to body weight status. The current study employed structural imaging from an open MRI data set (http://fcon_1000. PROJECTS: nitrc.org/indi/pro/nki.html) to examine the relationship between eating behavior traits and brain structural changes. The eating behavior traits were measured by the Three Factor Eating Questionnaire Scale. The brain structural alterations were analyzed using the Voxel Based Morphometry (VBM) method, and a multiple linear regression model was constructed to identify significant brain structural changes that related to eating behavior factors. We found that cognitive restraint of eating was positively correlated with the gray matter volume (GMV) in the dorsolateral prefrontal cortex (DLPFC) and negatively correlated with the GMV in the putamen; disinhibition scores were negatively associated with the GMV in the left middle frontal gyrus; hunger scores showed a positive correlation with the GMV in the hypothalamus and the visual memory areas and a negative association with the GMV in the inferior temporal gyrus and the bilateral middle frontal gyrus. These results indicated a close connection between the eating behavior traits and structural changes in particular brain regions. Conjunction analysis was also performed to further explore the brain structural alterations that were commonly associated with eating behavior and weight status. The findings add to our understanding of the neural basis underlying eating behaviors, and the connection between these behaviors and body weight status.

[Application of diffusion tensor imaging in judging infarction time of acute ischemic cerebral infarction].

OBJECTIVE: To evaluate the clinical application value of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in judging infarction time phase of acute ischemic cerebral infarction. METHODS: To retrospective analysis DTI images of 52 patients with unilateral acute ischemic cerebral infarction (hyper-acute, acute and sub-acute) from the Affiliated Yancheng Hospital of Southeast University Medical College, which diagnosed by clinic and magnetic resonance imaging. Set the regions of interest (ROIs) of infarction lesions, brain tissue close to infarction lesions and corresponding contra (contralateral normal brain tissue) on DTI parameters mapping of fractional anisotropy (FA), volume ratio anisotropy (VRA), average diffusion coefficient (DCavg) and exponential attenuation (Exat), record the parameters values of ROIs and calculate the relative parameters value of infarction lesion to contra. Meanwhile, reconstruct the DTT images based on the seed points (infarction lesion and contra). The study compared each parameter value of infarction lesions, brain tissue close to infarction lesions and corresponding contra, also analysed the differences of relative parameters values in different infarction time phases. RESULTS: The DTT images of acute ischemic cerebral infarction in each time phase could show the manifestation of fasciculi damaged. The DCavg value of cerebral infarction lesions was lower and the Exat value was higher than contra in each infarction time phase (P<0.05). The FA and VRA value of cerebral infarction lesions were reduced than contra only in acute and sub-acute infarction (P<0.05). The FA, VRA and Exat value of brain tissue close to infarction lesions were increased and DCavg value was decreased than contra in hyper-acute infarction (P<0.05). There were no statistic differences of FA, VRA, DCavg and Exat value of brain tissue close to infarction lesions in acute and sub-acute infarction. The relative FA and VRA value of infarction lesion to contra gradually decreased from hyper-acute to sub-acute cerebral infarction (P<0.05), but there were no difference of the relative VRA value between acute and sub-acute cerebral infarction. The relative DCavg value of infarction lesion to contra in hyper-acute infarction than that in acute and sub-acute infarction (P<0.05), however there was also no difference between acute and sub-acute infarction. ROC curve showed the best diagnosis cut off value of relative FA, VRA and DCavg of infarction lesions to contra were 0.852, 0.886 and 0.541 between hyper-acute and acute cerebral infarction, the best diagnosis cut off value of relative FA was 0.595 between acute and sub-acute cerebral infarction, respectively. CONCLUSION: The FA, VRA, DCavg and Exat value have specific change mode in acute ischemic cerebral infarction of different infarction time phases, which can be combine used in judging infarction time phase of acute ischemic cerebral infarction without clear onset time, thus to help selecting the reasonable treatment protocols.

[Application of multi-voxel proton magnetic resonance spectroscopy in different hippocampal regions of normal cognitive people].

OBJECTIVE: To explore the reproducible metabolic test and gender difference and investigate the distribution rules of metabolite concentration in different hippocampal regions (head, body and tail) of normal cognitive people for elucidating the pathological metabolic changes. METHODS: The hippocampal multi-voxel proton spectroscopy of 24 normal cognitive young volunteers scanned by a 3.0 T magnetic resonance (MR). Every volunteer was scanned thrice. The data was processed by MR post-processing workstation. The hippocampus was divided into three parts (head, body and tail) and the ratios of N-acetylaspartate (NAA)/creatine (Cr), myoinositol (MI)/Cr, MI/NAA and choline (Cho)/Cr were calculated separately. We compared the metabolic ratios of each region of bilateral hippocampi between male and female groups and three different tests, also analyzed the distribution rule of each metabolite along the long axis of hippocampus. RESULTS: The metabolic ratio (NAA/Cr, MI/Cr, MI/NAA and Cho/Cr) of each region of bilateral hippocampi between male and female groups and among three tests showed no statistical differences. NAA/Cr gradually rose (P < 0.05) while MI/NAA and Cho/Cr gradually declining from bilateral hippocampal head to tail (P < 0.05). MI/Cr gradually declined from bilateral hippocampal head to tail, but there was statistical difference only between right hippocampal head and tail (P < 0.05). CONCLUSION: The hippocampal multi-voxel proton spectroscopy is technically stable. There is no gender difference. And distribution differences and metabolite concentration trends exist along hippocampal head, body and tail.

Value of ultra-high b-value diffusion-weighted imaging for the evaluation of renal ischemia-reperfusion injury.

To explore the feasibility of ultra-high b-value diffusion-weighted imaging (ubDWI) in assessment of renal IRI. Thirty-five rabbits were randomized into a control group (n = 7) and a renal IRI group (n = 28). The rabbits in the renal IRI group underwent left renal artery clamping for 60 min. Rabbits underwent axial ubDWI before and at 1, 12, 24, and 48 h after IRI. Apparent diffusion coefficient (ADCst) were calculated from ubDWI with two b-values (b = 0, 1000 s/mm2). Triexponential fits were applied to calculate the pure diffusion coefficients (D), perfusion-related diffusion coefficient (D⁎), and ultra-high ADC (ADCuh). The interobserver reproducibility were evaluated. The repeated measurement analysis of variance and Spearman correlation analysis was used for statistical analysis. The ADCst, D, and ADCuh values showed good reproducibility. The ADCst, D, and D⁎ values of renal Cortex (CO) and outer medulla (OM) significantly decreased after IRI (all P < 0.05). The ADCuh values significantly increased from pre-IRI to 1 h after IRI (P < 0.05) and significantly declined at 24 h and 48 h after IRI (all P < 0.05). ADCuh was strongly positively correlated with AQP-1 in the renal CO and OM (ρ = 0.643, P < 0.001; ρ = 0.662, P < 0.001, respectively). ubDWI can be used to non-invasively evaluate early renal IRI, ADCuh may be adopted to reflect AQP-1 expression.

Evaluation of CT features for differentiating consolidation pattern of pulmonary MALT lymphoma from pneumonic-type lung adenocarcinoma.

Purpose: In clinical practice, the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (C-MALT) was often misdiagnosed as pneumonic-type lung adenocarcinoma (P-LADC). However, the mainstay of treatment and prognosis of these two diseases are different. The purpose of this study was to distinguish C-MALT from P-LADC by pre-treatment chest computed tomography (CT) features. Patients and methods: A total of 31 patients with C-MALT (15 men and 16 women; mean age, 61.1 ± 11.2 years) and 58 patients with P-LADC (34 men and 24 women; mean age, 68.6 ± 7.4 years) confirmed by pathology who underwent contrast-enhanced chest CT were retrospectively enrolled from September 2014 to February 2023. Detailed clinical and CT characteristics of the two groups were evaluated. Logistic regression analysis was used to assess the effectiveness of statistically significant variables in distinguishing C-MALT from P-LADC. Results: The average age of C-MALT was younger than P-LADC patients (p<0.001). With regard to CT features, bronchiectasis within the consolidation was more common in the C-MALT group than the P-LADC group [83.87% (26 of 31) vs 20.69% (12 of 58), p<0.001]; whereas lymph nodes enlargement [75.86% (44 of 58) vs 9.68% (3 of 31), p<0.001] and pleural effusion [43.10% (25of 58) vs 19.35% (6 of 31), p=0.025] were more frequently observed in the P-LADC group than C-MALT group. The predictors with p<0.05 (age, bronchiectasis, lymph node enlargement, and pleural effusion) were used to construct a logistic regression model in discriminating C-MALT from P-LADC, the area under curve (AUC), positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy were 0.9555, 86.67%, 91.53%, 83.87%, 93.10%, and 89.89%, respectively. Conclusion: C-MALT and P-LADC have differential clinical and CT features. An adequate understanding of these different characteristics can contribute to the early accurate diagnosis of C-MALT and provide an appropriate therapeutic strategy.

Differential diagnostic value of tumor markers and contrast-enhanced computed tomography in gastric hepatoid adenocarcinoma and gastric adenocarcinoma.

Objective: This study aimed to investigate the effectiveness of tumor markers and contrast-enhanced computed tomography (CE-CT) in differentiating gastric hepatoid adenocarcinoma (GHA) from gastric adenocarcinoma (GA). Methods: This retrospective study included 160 patients (44 with GHA vs. 116 with GA) who underwent preoperative CE-CT. Preoperative serum concentrations of tumor biomarkers and CT imaging features were analyzed, including alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), tumor location, growth pattern, size, enhancement pattern, cystic changes, and mass contrast enhancement. Multivariate logistic regression analyses were performed to evaluate useful tumor markers and CT imaging features for differentiating GHA from GA. Results: When compared to GA, GHA showed a higher serum AFP [13.27 ng/ml (5.2-340.1) vs. 2.7 ng/ml (2.2-3.98), P <0.001] and CEA levels [4.07 ng/ml (2.73-12.53) vs. 2.42 ng/ml (1.38-4.31), P <0.001]. CT imaging showed GHA with a higher frequency of tumor location in the gastric antrum (P <0.001). GHA had significantly lower attenuation values at the portal venous phase [PCA, (82.34 HU ± 8.46 vs. 91.02 HU ± 10.62, P <0.001)] and delayed phase [DCA, (72.89 HU ± 8.83 vs. 78.27 HU ± 9.51, P <0.001)] when compared with GA. Multivariate logistic regression analyses revealed that tumor location, PCA, and serum AFP level were independent predictors of differentiation between GHA and GA. The combination of these three predictors performed well in discriminating GHA from GA, with an AUC of 0.903, a sensitivity of 86.36%, and a specificity of 81.90%. Conclusions: Integrated evaluation of tumor markers and CT features, including tumor location, PCA, and serum AFP, allowed for more accurate differentiation of GHA from GA.

Association of cerebral microvascular perfusion and diffusion dynamics detected by intravoxel incoherent motion-diffusion weighted imaging with initial neurological function and clinical outcome in acute ischemic stroke.

BACKGROUND: This work aimed to explore the association of cerebral microvascular perfusion and diffusion dynamics measured by intravoxel incoherent motion (IVIM) imaging with initial neurological function and clinical outcome in acute stroke. METHODS: In total, 39 patients were assessed with admission National Institutes of Health Stroke Scale (NIHSS) and day-90 modified Rankin Scale (mRS). The parametrical maps of IVIM were obtained, including apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (D*), true diffusion coefficient (D) and perfusion fraction (f). The fD* was the product of f and D*. Moreover, the ratios of lesioned/contralateral parameters (rADC, rD, rD*, rf and rfD*) were also obtained. The differences of these parameters between the poor outcome group and good outcome group were evaluated. Partial correlation analysis was used to evaluate the correlations between the admission NIHSS/day-90 mRS and each parameter ratio, with lesion volumes controlled. RESULTS: The ADC, D, D*, f and fD* values of lesions were significantly reduced than those of the contralateral regions. The rADC and rD were significantly decreased in the poor outcome group than good outcome group (all p < 0.01). With lesion volume controlled, rADC showed a weak negative correlation (r = -0.340, p = 0.037) and a notable negative correlation (r = -0.688, p < 0.001) with admission NIHSS score and day-90 mRS score, respectively. In addition, rD showed a strong negative correlation (r = -0.731, p < 0.001) with day-90 mRS score. CONCLUSION: Significant negative correlations were revealed between IVIM derived diffusion dynamics parameters and initial neurological function as well as clinical outcome for patients with acute ischemic stroke. IVIM can be therefore suggested as an effective non-invasive method for evaluating the acute ischemic stroke.

Dynamic Changes in the Systemic Inflammation Response Index Predict the Outcome of Resectable Gastric Cancer Patients.

The systemic inflammation response index (SIRI) has been revealed to be closely related to the prognosis of a variety of tumors. Whether the dynamic change in SIRI before and after surgery can be used to judge the prognosis of patients after radical gastrectomy has not yet been studied. In this study, the predictive ability of preoperative SIRI and changes in SIRI before and after surgery for the survival rate of gastric cancer patients was evaluated in two independent cohorts. It was found that SIRI was closely related to TNM staging. The higher the TNM stage, the higher the proportion of patients with a high SIRI. However, SIRI was not related to any other clinicopathological parameters. Kaplan-Meier survival analysis showed that a high SIRI was associated with poor prognosis in gastric cancer patients in the original cohort and in the validation cohort. SIRI, NLR, PLR, and MLR could be used to judge the prognosis of patients with operable gastric cancer. However, multivariate analysis suggested that only SIRI was an independent prognostic factor for patients with operable gastric cancer. In addition, the change in SIRI at 4 to 6 weeks after surgery compared with SIRI before surgery was closely related to the survival of gastric cancer patients. Compared with the unchanged group (absolute variation <50%), gastric cancer patients with a SIRI increase >50% had a worse OS, while patients with a SIRI decrease >50% had a better prognosis. In conclusion, SIRI can be used as a reliable index to evaluate the prognosis of patients with operable gastric cancer, and the dynamic change in SIRI before and after surgery is significantly related to the prognosis of patients with gastric cancer.